What’s your initial reaction to the idea of undocumented immigrants receiving organ transplants in the United States?

If you balked at this, is that response based on the rationale that it wouldn’t be fair to allow an individual living illegally in the U.S. access to an already scarce resource — viable organs desperately needed by critically ill patients?

Or, are you more pragmatic, immediately considering some of the practicalities involved – are undocumented immigrants insured? And if not, who is going to cover the cost of the procedure and subsequent treatments necessary to prevent rejection of the new organ?

Let’s look at the costs and consider fairness.

Maybe you’ve heard that every 10 minutes, someone is added to the national transplant waiting list. Or that 22 people die each day waiting for a transplant organ. So, it’s obvious the demand for organs far outpaces their availability. On average, only 54% of adults are registered for organ donation, but this figure differs so widely by state that we see 86% registration in Alaska but only 26% registration in New York.

You can visit your state’s donor registry and sign up at any time, but a majority of people are only confronted with the decision to opt-in when they obtain or renew their state driver’s license.

As of 2016, 12 states and the District of Columbia permit undocumented immigrants to obtain driver’s licenses. When AB60 was passed in California, allowing anyone that could prove their identity and California residency to apply for a driver’s license, they saw a huge spike in organ donor registration, a 30% increase over the same time period from the previous year. After similar legislation in Illinois, 45% of those signing up for driver’s licenses also joined the donor registry.

So people in the U.S. illegally can donate organs. In fact, between March 2012 and December 2013, 3.3% of organ donations came from US residents who were non-citizens. That’s donors, not people registered to donate. To put into perspective the number of people registered for organ donation versus those that become donors, although 2.2 million individuals were registered in 2010 in Massachusetts, less than 250 became organ donors.

Who can legally receive a transplant? The Organ Procurement and Transplantation Network policies don’t exclude undocumented immigrants from receiving transplant organs. In fact, the National Organ Transplant Act requires that only medical criteria is used to determine who receives an available organ. The variety of factors considered can include the geographical location of the patient and the donated organ, medical need, time on the waiting list, and physical matching of blood and tissue type. Citizenship is not permitted to play a role in who is placed on the wait list. Ability to pay is. Health insurance may be a requirement for even being listed.

Then isn’t this a problem for all uninsured? Even U.S. citizens? Well, yes. But U. S. citizens have much greater flexibility in their ability to obtain insurance – whether through the workplace, the marketplace, Medicaid, or Medicare. Granted, none of these options feel particularly flexible, and the lack of access to affordable health care is a huge problem across the country. But undocumented immigrants are not eligible for marketplace insurance and are barred from Medicaid and Medicare. And as far as the workplace, it’s a crime for an employer to knowingly hire anyone without the legal ability to work in the U.S. Since they can’t obtain health insurance, in most cases undocumented immigrants won’t even make it onto the transplant list.

It won’t surprise you that medical costs associated with organ transplants are prohibitive for the uninsured. This extends beyond the initial surgery to a lifetime of anti-rejection medications. But those that cannot receive transplants end up costing U.S. taxpayers more money than the transplants and subsequent treatments combined because hospitals don’t turn away people that show up at an emergency room – they are treated regardless of ability to pay or citizenship status. Perhaps a kidney transplant would cost $100,000 initially with $10,000 every year after in medications, but dialysis in lieu of transplant can run $80,000 a year. Some states will cover scheduled dialysis, and emergency dialysis is even more costly. So prohibiting undocumented immigrants from receiving transplants by requiring health insurance to be put on the organ transplant list doesn’t save money.

Prior to the Affordable Care Act (ACA), insurance companies could charge higher premiums or deny coverage altogether based on an individual’s medical history or health status. The ACA included protections for those with pre-existing health conditions.

Pre-existing conditions differ from insurer to insurer, but they generally designate an individual with a health condition requiring medical treatment or someone who has a greater likelihood of illness and injury due to occupation or lifestyle.

It’s apparent that some of the individuals previously unable to obtain medical insurance due to pre-existing conditions were children, but how many?

Using a breakdown by the Center for American Progress that summarizes these numbers by age and state, we were able to determine how many children were affected on a state-by-state basis and which states had the highest percentages of children in the population with pre-existing conditions.

So, when you’re talking about residents of Utah (ranking #1) losing coverage for pre-existing conditions, around 18% of those impacted are kids. But even where the percentage is lowest in Vermont, the under-18 group still adds up to 11% of those that would be impacted.

A removal of these protections has nationwide impact for both adults and children. Of the 134 million individuals under age 65 that could lose coverage, 17.5 million (13%) are under 18.

1970: Congress passed the Clean Air Act and created the Environmental Protection Agency (EPA).

1990: The Clean Air Act Amendments expanded the original law.

But what does this mean today? What has the Clean Air Act accomplished?

AIR QUALITY

On average, levels of the 6 main tracked air pollutants have decreased. Percentages below reflect 1990 – 2015 change.

Particles: Down by 39%

Ozone: Down by 22%

Lead: Down by 99%

Carbon Monoxide: Down by 77%

Nitrogen Dioxide: Down by 47%

Sulfur Dioxide: Down by 81%

HEALTH BENEFITS

A significant number of deaths and a staggering number of illnesses were prevented by the Clean Air Act.

Adult Mortality: 160,000 deaths prevented

Infant Mortality: 230 deaths prevented

Chronic Bronchitis: 54,000 cases prevented

Acute Bronchitis: 130,000 cases prevented

Asthma Exacerbation: 1,700,000 cases prevented

This has substantially increased U.S. worker productivity because 13 million workdays were not lost due to air pollution-influenced afflictions. Using the same formula for monetization of productivity loss detailed in this report by the National Center for Biotechnology Information to capture health-related productivity loss (multiplying the number of days lost by the average hourly wage plus benefits of $29.18 for U.S. civilian workers, using 8 hour days and the cost to an employer multiplier of 1.61), we can see that U.S. employers have saved $4.9 billion.

ECONOMIC IMPACT

A common objection to environmental regulation is that it hurts the economy. Despite the savings just identified, we can also see that the overall GPA did not decline during the time period when EPA enforcement of the Clean Air Act improved air quality and decreased pollutant emissions. (Source: epa.gov)

ARE WE DONE?

While the average air quality has drastically improved, there are still many counties where air quality is abysmal. The EPA estimates 127 million people live in counties with ground ozone levels above the national standard.

Are you interested in more information? The EPA has some fascinating tools and data.

Since the passing of the 1973 U. S. Endangered Species Act, with regulation, public education, and intervention efforts by conservationists, 47 species have recovered enough to be removed from the listing. Without those efforts, the following 11 species would most likely be extinct.

When wading into stories on the origin of Valentine’s Day, it’s difficult to know where history stops and legend begins. But somehow, this amalgamation of death, sex, celebration, poetry, card-printing, and love has led to our current flower-infused and chocolate-scented version of the holiday on February 14.

The year 2016 represented record spending of $19.7 billion for Valentine’s Day, and figures for 2017 are not expected to top it.

Words have an impact. And, over the last two decades, the number of extremist groups with hateful ideologies is rising. Obviously not all these groups are violent, but then we see unhinged individuals spouting the same hate-filled rhetoric as they perpetrate violence against individuals, police officers, and communities.

Some believe that their race is superior and others that the end of days is approaching, but an anti-government message resonates loudly with many of these extremists as they stockpile weapons and denigrate others.

After surveying 382 law enforcement groups, the Triangle Center on Terrorism and Homeland Security concluded: “Law enforcement agencies in the United States consider anti-government violent extremists, not radicalized Muslims, to be the most severe threat of political violence that they face.”

For an absolutely fascinating and frightening look at hate groups near you, check out the Southern Poverty Law Center’s Hate Map.